Agents of Bioterrorism Flashcards

1
Q

What are the categories of bioterrorism agents and a general description of the catergory?

A

Category A- easily disseminated, transmitted person-person, high mortality, potential major public health impact, panic or social disruption, special prep; B- 2nd highest, moderate morbidity, low mortality, moderate dissemination; C- 3rd, emerging pathogens that could be engineered for mass dissemination

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2
Q

What are the normal epidemiologic features of anthrax?

A

resevior- herbivores (goats, sheep, cattle), wollsortter’s disease, soil- cell poor survival, spores (decades)

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3
Q

What are the virulence factors of anthrax?

A

antiphagocytic capsule- poly D glutamic acid, plasmid encoded (pX02), endotoxins- PA- protective Ag (binding site non-toxic), EF- edema factor (andenylate cyclase), lethal factor (protease), plasmid encoded (pX01); non-encapsulated is not virulent, 1 plasmid for capsule and 1 for toxin

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4
Q

Describe the mechanism of anthrax.

A

PA binds cell receptor, 7 PAs bound to receptor form a big compound and will bind 3 of either EF or LF (any combo), endocytosis, acidification of endosome by host cell casues secretion of EF/LF, EF- inc cAMP causing inhibition of phagocytosis and edema, LF- dec. MAPK-> apoptosis and cytokine production, necrosis and hypoxia

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5
Q

What are the types of anthrax? Which method is bioterrorism delivery?

A

cutaneous, GI, and inhalation (pulmonary, bioterrorism)

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6
Q

what are the features of cutaneous anthrax? GI?

A

most common (esp developing countries), septicemia rare, mortality <1%; extremely rare (none in US)

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7
Q

What are the features of inhalation (Pulmonary) anthrax?

A

spore germinate in lungs, not communicable, onset flu-like- SOB, sweats, fever/chills, fatigue, non-prod. cough, N/V, chest/muscle pain, headache; mediastinal widening on CXR, septicemic spread, rapid onset death 3-7d, resp fail, shock, meningitis, untreated 100% fatal

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8
Q

How is anthrax diagnosed?

A

blood/CSF culture- medusa head colonies, phenotypical or biochemical characteristics, PCR (RT-PCR), ELISA, or DFA; purple on outside, capsule doesn’t stain

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9
Q

What us the therapy for anthrax?

A

ciprofloxacin or tetracycline; unless genetically selected against, then good chance gram + antibiotic will work

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10
Q

Who gets an anthrax vaccine?

A

military, lab workers; new recombinant vaccine under way, current vaccine poor

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11
Q

what are the general features of Yersinia pestis?

A

plague, enterobacter., “safety pin” bipolar staining, single most significant disease in W. civilization, killed 1/3 pop, “Black death”

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12
Q

what is the epidemiology of Y pestis in US? Sylvatic plague? Urban plague?

A

SW, fleas feeding on squirrels, prairie dogs, chipmunks, etc; S- flea to rodent to flea to rodent, humans get close to sick rodent and flea hops to human; U- rodent (wild) to flea to rodent (urban-rat) then flea to human; Y pestis grows in flea, regurgitated into host with next blood meal

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13
Q

What are the virulence factors of Y. Pestis?

A

many!!! big component of disease is the cytokine storm

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14
Q

What is the presentation, signs and symptoms of bubonic plague?

A

1-7d incubation after flea bite, fever, chills, headache, exhaustion, spreads to lymph nodes (unilateral), develop bubo (enlarged tender lymph node) esp groin, neck and armpit, skin hemorrhages- capillaries = black death, shock, death, mortality 8% treated >50% untreated, no person to person

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15
Q

How is pneumonic plague transmitted?

A

flea to rodent cycle, flea to human-> bubonic-> systemic spread to lungs (few patients), then aerolosized in lungs and spread out (person to person)

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16
Q

What is the presentation, signs and symptoms of bubonic plague? (bioterrorism)

A

1-4d incubation after inhalation (1-10 org), flu-like symp. w/ high fever, cough/bloody sputum, shock, death, mortality ~100% untreated and ~15% treated, person to person transmission

17
Q

What is the drug of choice for confirmed plague?

A

streptomycin (difficult to get but other similar options exist)

18
Q

How is plague prevented?

A

no vaccine, sylvatic/urban: bug repellant, pre-exposure prophylaxis AB, pneumonic- droplet precautions

19
Q

What are the general features of Franciscella tularensis?

A

zoonotic gram (-) coccobacillus, obligate aerobe, facultative intracellular w/ macrophage (other ~10), causes rabbit fever, reservoir- rabbits, sheep, squirrels, deer etc, can be in food/water contaminated, or aerosol- bioterrorism

20
Q

What are the tularemia types?

A

ulceroglandular (most common), glandular, occuloglandular, oropharyngeal and GI, pneumonic, and typhoidal

21
Q

What are the signs and symptoms with ulceroglandular Tularemia?

A

skin (scratch or abrasion) or insect/tick bite, ulcer at site of infection, swollen painful lymph glands, fever, chills, headache, exhaustion

22
Q

What are the signs and symptoms with glandular Tularemia?

A

swollen painful lymph glands, fever, chills, headache, exhaustion

23
Q

What are the signs and symptoms with oculoglandular Tularemia?

A

eye pain/ redness/ swelling/ discharge, ulcer inside eyelid

24
Q

What are the signs and symptoms with oropharyngeal Tularemia?

A

digestive tract, fever, pharyngitis, mouth ulcers, vomiting, diarrhea

25
Q

What are the signs and symptoms with pneumonic Tularemia?

A

inhalation; cough, chest pain, difficulty breathing, respiratory failure, death, most likely bioterror mode, 30-60% fatal if untreated- respiratory failure

26
Q

What are the signs and symptoms with typhoidal Tularemia?

A

consequence of any primary exposure leading to septicemia, high fever, extreme exhaustion, vomiting diarrhea, splenomegaly, hepatomegaly, and pneumonia

27
Q

How is tularemia diagnosed?

A

workup in BSC, presumptive ID: gram stain, slow growing colonies on CHOC and none on BAP, oxidase and urease (-), weak catalase (+), confirmation PCR at Lab response network, reportable agent, document destruction of isolate

28
Q

How is tularemia treated? prevented?

A

DOC: gentamicin (streptomycin), fatal if not treated 30-60%; vaccine- investigational but available w/ informed consent

29
Q

what are the virulent features of Clostridium Botulinum Toxin?

A

most lethal substance known, aerosolized- 200g could kill entire US, neurotoxin- prevent ACh release, muscle contraction both voluntary and diaphragm

30
Q

What is the presentation, signs, and symptoms of botulism?

A

onset 12-36hrs, early- dry mouth, blurred/double vision, late- symmetric descending weakness, diplopia, dysphagia, dysphonia, respiratory paralysis, death

31
Q

What mechanisms can be employed for botulinum toxin in bioterrorism?

A

food/water, aerosol- inhalation= 100x more potent

32
Q

How infectious is Burkholderia mallei? Routes and symptoms with each?

A

Glanders-Low infectious dose
Symptoms: Cutaneous-multiple abscesses; Eye, nose, other mucous membranes-mucopurulent discharge; Pulmonary/systemic-fever, myalgia, headache, chest pain, diarrhea

33
Q

What does Burkeholderia pseudomallei cause?

A

Melioidosis (glanders-like)